Semin Respir Crit Care Med
DOI: 10.1055/s-0044-1787560
Review Article

Lung Transplant for Chronic Obstructive Pulmonary Disease

Kyle Swartz
1   Department of Pulmonary and Critical Care Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
,
Ali Mansour
2   Department of Cardiovascular and Thoracic Surgery, Montefiore Medical Center, Bronx, New York
3   Department of Cardiovascular & Thoracic Surgery, Albert Einstein College of Medicine, Bronx, New York
,
Sammar Alsunaid
2   Department of Cardiovascular and Thoracic Surgery, Montefiore Medical Center, Bronx, New York
3   Department of Cardiovascular & Thoracic Surgery, Albert Einstein College of Medicine, Bronx, New York
› Author Affiliations

Abstract

Chronic obstructive pulmonary disease (COPD) carries a high burden of morbidity and mortality to patient and a high cost to health care systems. Lung transplantation is a last resort available for end-stage COPD patients interested in pursuing it and meeting the strict transplant requirements. It requires commitment from patients and their loved ones to support them through this tough process. This review will cover history of transplant, indications, candidate selection, evaluation testing, transplant listing, type of transplant (single versus bilateral), posttransplant complications, immunosuppression, and rejection. It is tailored to the COPD patient when applicable; however, many aspects of lung transplantation are shared amongst all lung diseases eligible for transplant.



Publication History

Article published online:
19 July 2024

© 2024. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 
  • References

  • 1 Agustí A, Celli BR, Criner GJ. et al. Global Initiative for Chronic Obstructive Lung Disease 2023 Report: GOLD executive summary. Am J Respir Crit Care Med 2023; 207 (07) 819-837
  • 2 Cagle Jr SD, Landrum LS, Kennedy AM. Chronic obstructive pulmonary disease: diagnosis and management. Am Fam Physician 2023; 107 (06) 604-612
  • 3 Celli BR, Cote CG, Marin JM. et al. The body-mass index, airflow obstruction, dyspnea, and exercise capacity index in chronic obstructive pulmonary disease. N Engl J Med 2004; 350 (10) 1005-1012
  • 4 Bellou V, Belbasis L, Konstantinidis AK, Tzoulaki I, Evangelou E. Prognostic models for outcome prediction in patients with chronic obstructive pulmonary disease: systematic review and critical appraisal. BMJ 2019; 367: l5358
  • 5 Ryrsø CK, Godtfredsen NS, Kofod LM. et al. Lower mortality after early supervised pulmonary rehabilitation following COPD-exacerbations: a systematic review and meta-analysis. BMC Pulm Med 2018; 18 (01) 154
  • 6 Everaerts S, Vandervelde CM, Shah P, Slebos D-J, Ceulemans LJ. Surgical and bronchoscopic pulmonary function-improving procedures in lung emphysema. Eur Respir Rev 2023; 32 (170) 230004
  • 7 Holden VK. et al. Endobronchial lung volume reduction therapies. Curr Pulmonol Rep 2021; 10: 1-13
  • 8 Leard LE, Holm AM, Valapour M. et al. Consensus document for the selection of lung transplant candidates: an update from the International Society for Heart and Lung Transplantation. J Heart Lung Transplant 2021; 40 (11) 1349-1379
  • 9 Fuehner T, Clajus C, Fuge J. et al. Lung transplantation after endoscopic lung volume reduction. Respiration 2015; 90 (03) 243-250
  • 10 National data - OPTN. Accessed May 15, 2024 at: https://optn.transplant.hrsa.gov/data/view-data-reports/national-data/#
  • 11 Hardy JD, Webb WR, Dalton Jr ML, Walker Jr GR. Lung homotransplantation in man. JAMA 1963; 186: 1065-1074
  • 12 Nelems JM, Rebuck AS, Cooper JD, Goldberg M, Halloran PF, Vellend H. Human lung transplantation. Chest 1980; 78 (04) 569-573
  • 13 Chang SH, Chan J, Patterson GA. History of lung transplantation. Clin Chest Med 2023; 44 (01) 1-13
  • 14 Reitz BA, Wallwork JL, Hunt SA. et al. Heart-lung transplantation: successful therapy for patients with pulmonary vascular disease. N Engl J Med 1982; 306 (10) 557-564
  • 15 Toronto Lung Transplant Group. Unilateral lung transplantation for pulmonary fibrosis. N Engl J Med 1986; 314 (18) 1140-1145
  • 16 Patterson GA, Cooper JD, Dark JH, Jones MT. Experimental and clinical double lung transplantation. J Thorac Cardiovasc Surg 1988; 95 (01) 70-74
  • 17 Cooper JD, Pearson FG, Patterson GA. et al. Technique of successful lung transplantation in humans. J Thorac Cardiovasc Surg 1987; 93 (02) 173-181
  • 18 Pasque MK, Cooper JD, Kaiser LR, Haydock DA, Triantafillou A, Trulock EP. Improved technique for bilateral lung transplantation: rationale and initial clinical experience. Ann Thorac Surg 1990; 49 (05) 785-791
  • 19 Shinoi K, Hayata Y, Aoki H. et al. Pulmonary lobe homotransplantation in human subjects. Am J Surg 1966; 111 (05) 617-628
  • 20 Date H. Current status and problems of lung transplantation in Japan. J Thorac Dis 2016; 8 (Suppl. 08) S631-S636
  • 21 Saddoughi SA, Cypel M. Expanding the lung donor pool: donation after circulatory death, ex-vivo lung perfusion and hepatitis C donors. Clin Chest Med 2023; 44 (01) 77-83
  • 22 Chambers DC, Perch M, Zuckermann A. et al; International Society for Heart and Lung Transplantation. The International Thoracic Organ Transplant Registry of the International Society for Heart and Lung Transplantation: Thirty-eighth adult lung transplantation report - 2021; focus on recipient characteristics. J Heart Lung Transplant 2021; 40 (10) 1060-1072
  • 23 Chambers DC, Cherikh WS, Harhay MO. et al; International Society for Heart and Lung Transplantation. The International Thoracic Organ Transplant Registry of the International Society for Heart and Lung Transplantation: Thirty-sixth adult lung and heart-lung transplantation Report-2019; Focus theme: Donor and recipient size match. J Heart Lung Transplant 2019; 38 (10) 1042-1055
  • 24 Mannem H, Aversa M, Keller T, Kapnadak SG. The lung transplant candidate, indications, timing, and selection criteria. Clin Chest Med 2023; 44 (01) 15-33
  • 25 Rudym D, Natalini JG, Trindade AJ. listing dilemmas: age, frailty, weight, preexisting cancers, and systemic diseases. Clin Chest Med 2023; 44 (01) 35-46
  • 26 Subramanian M, Meyers BF. Lung transplant procedure of choice: bilateral transplantation versus single transplantation complications, quality of life, and survival. Clin Chest Med 2023; 44 (01) 47-57
  • 27 Meyer DM, Bennett LE, Novick RJ, Hosenpud JD. Single vs bilateral, sequential lung transplantation for end-stage emphysema: influence of recipient age on survival and secondary end-points. J Heart Lung Transplant 2001; 20 (09) 935-941
  • 28 Thabut G, Christie JD, Ravaud P. et al. Survival after bilateral versus single lung transplantation for patients with chronic obstructive pulmonary disease: a retrospective analysis of registry data. Lancet 2008; 371 (9614) 744-751
  • 29 Cassivi SD, Meyers BF, Battafarano RJ. et al. Thirteen-year experience in lung transplantation for emphysema. Ann Thorac Surg 2002; 74 (05) 1663-1669 , discussion 1669–1670
  • 30 Bennett DT, Zamora M, Reece TB. et al. Continued utility of single-lung transplantation in select populations: chronic obstructive pulmonary disease. Ann Thorac Surg 2015; 100 (02) 437-442
  • 31 Mutyala S, Kashem MA, Kanaparthi J. et al. Comparing outcomes in patients with end-stage chronic obstructive pulmonary disease: single versus bilateral lung transplants. Interact Cardiovasc Thorac Surg 2021; 33 (05) 807-813
  • 32 Hull TD, Leya GA, Axtell AL. et al. Lung transplantation for chronic obstructive pulmonary disease: a call to modify the lung allocation score to decrease waitlist mortality. J Thorac Cardiovasc Surg 2022; 164 (04) 1222-1233.e11
  • 33 Eberlein M, Garrity ER, Orens JB. Lung allocation in the United States. Clin Chest Med 2011; 32 (02) 213-222
  • 34 Egan TM, Murray S, Bustami RT. et al. Development of the new lung allocation system in the United States. Am J Transplant 2006; 6 (5 Pt 2): 1212-1227
  • 35 A guide to calculating the lung allocation score. Accessed May 31, 2024 at: https://unos.org/wp-content/uploads/unos/lung-allocation-score.pdf
  • 36 Wille KM, Edwards LB, Callahan LR, McKoy AR, Chan KM. Characteristics of lung allocation score exception requests submitted to the national Lung Review Board. J Heart Lung Transplant 2017; 36 (07) 812-814
  • 37 Egan TM, Edwards LB. Effect of the lung allocation score on lung transplantation in the United States. J Heart Lung Transplant 2016; 35 (04) 433-439
  • 38 Egan TM. How should lungs be allocated for transplant?. Semin Respir Crit Care Med 2018; 39 (02) 126-137
  • 39 Lung Composite Allocation Score (CAS) Calculator - OPTN. Accessed May 15, 2024 at: https://optn.transplant.hrsa.gov/data/allocation-calculators/lung-cas-calculator/
  • 40 Tsuang WM, Lease ED, Budev MM. The past, present, and near future of lung allocation in the United States. Clin Chest Med 2023; 44 (01) 59-68
  • 41 Natalini JG, Clausen ES. Critical care management of the lung transplant recipient. Clin Chest Med 2023; 44 (01) 105-119
  • 42 Hachem RR, Edwards LB, Yusen RD, Chakinala MM, Alexander Patterson G, Trulock EP. The impact of induction on survival after lung transplantation: an analysis of the International Society for Heart and Lung Transplantation Registry. Clin Transplant 2008; 22 (05) 603-608
  • 43 Kumar A, Advani S, Asim K. et al. Hyperammonemia in lung transplant patients and its management: a review. Indian J Thorac Cardiovasc Surg 2022; 38 (Suppl. 02) 335-346
  • 44 Martinu T, Chen D-F, Palmer SM. Acute rejection and humoral sensitization in lung transplant recipients. Proc Am Thorac Soc 2009; 6 (01) 54-65
  • 45 Roden AC, Aisner DL, Allen TC. et al. Diagnosis of acute cellular rejection and antibody-mediated rejection on lung transplant biopsies: a perspective from members of the Pulmonary Pathology Society. Arch Pathol Lab Med 2017; 141 (03) 437-444
  • 46 Stewart S, Fishbein MC, Snell GI. et al. Revision of the 1996 working formulation for the standardization of nomenclature in the diagnosis of lung rejection. J Heart Lung Transplant 2007; 26 (12) 1229-1242
  • 47 Halverson LP, Hachem RR. Antibody-mediated rejection: diagnosis and treatment. Clin Chest Med 2023; 44 (01) 95-103
  • 48 Levine DJ, Glanville AR, Aboyoun C. et al. Antibody-mediated rejection of the lung: a consensus report of the International Society for Heart and Lung Transplantation. J Heart Lung Transplant 2016; 35 (04) 397-406
  • 49 Verleden GM, Glanville AR, Lease ED. et al. Chronic lung allograft dysfunction: definition, diagnostic criteria, and approaches to treatment-a consensus report from the Pulmonary Council of the ISHLT. J Heart Lung Transplant 2019; 38 (05) 493-503